门静脉左支矢状部与静脉导管的夹角及静脉导管直径对新生儿脐静脉置管成功率的影响

Diameter of ductus venous and angle between ductus venous and sagittal part of left portal vein associated with success rate of neonatal umbilical venous catheterization

目的:分析门静脉左支矢状部与静脉导管的夹角(angle between sagittal part of left portal vein and ductus venosus,AsLPVDV)及静脉导管直径(diameter of ductus venous,DDV)对新生儿脐静脉置管(umbilical vein catheterization,UVC)成功率的影响。方法:回顾性选取2020年4月至2021年1月在甘肃省妇幼保健院新生儿科收治的需要UVC的80例新生儿。根据UVC结果分为成功组(脐导管一次或多次送管后通过静脉导管,n=76)与失败组(脐导管未能通过静脉导管,n=4);一次性成功组(脐导管送管一次性通过静脉导管,n=43)和非一次性成功组(脐导管多次送管后通过静脉导管或脐导管未能通过静脉导管,n=37)。UVC前床旁超声测量AsLPVDV、DDV,置管受阻者应用实时超声监测下按压腹部、右侧卧位引导置管。观察UVC成功率和比较不同组间AsLPVDV、DDV的差异。采用χ2检验、t检验、秩和检验进行组间比较,应用受试者工作特征(receiver operating characteristic,ROC)曲线评估AsLPVDV和DDV预测UVC一次性成功的灵敏度和特异度。结果:80例新生儿UVC成功率为95%(76/80),其中一次性成功率为53.8%(43/80)。UVC成功组AsLPVDV和DDV均大于失败组[(142.2±8.3)°与(133.6±3.2)°、(3.0±0.4)与(1.8±0.4)mm,t值分别为6.284和2.064,P值均<0.05],一次性成功组的AsLPVDV和DDV均大于非一次性成功组[(147.5±6.2)°与(135.2±4.7)°、(3.1±0.3)与(2.8±0.6)mm,t值分别为9.956和2.939,P值均<0.05]。应用ROC曲线分析显示AsLPVDV和DDV评估UVC一次性成功的ROC曲线下面积分别为0.944(95%CI:0.869~0.983)和0.811(95%CI:0.708~0.890),最佳界值分别为140.4°和2.9 mm,灵敏度分别为93.0%和90.7%,特异度分别为91.9%和64.9%。结论:UVC成功与AsLPVDV和DDV有关。AsLPVDV对预测UVC一次性成功具有较高的价值。

Objective To explore the effect of the angle between sagittal part of left portal vein and ductus venous(AsLPVDV),and the diameter of ductus venous(DDV)on the success rate of umbilical venous catheterization(UVC)in neonates.Methods This was a retrospective study including 80 neonates requireing UVC in Gansu Provincial Women and Child-care Hospital from April 2020 to January 2021.According to the results of UVC,they were grouped into the success group(successful insertion of catheter,n=76)and failure group(failed to insert,n=4),or one-time success group(successful after first insertion attempt,n=43)and non-one-time success group(successful after several attempts or failed to insert,n=37).The AsLPVDV and the DDV were measured before UVC by bedside ultrasound.For those with obstruction of catheterization were guided by pressing the abdomen in right side recumbent position under real-time ultrasound monitoring.The success rate of UVC and the differences of AsLPVDV and DDV among different groups were compared.Chi-square test,t test,or U test were adopted for the comparison among groups.Receiver operating characteristic(ROC)curve was used to evaluate the sensitivity and specificity of the AsLPVDV and the DDV in predicting the one-time success of UVC.Results The total success rate of UVC was 95%(76/80)and the one-time success rate was 53.8%(43/80).A larger AsLPVDV and DDV were observed in the success group compared with the failure group[(142.2±8.3)°vs(133.6±3.2)°,(3.0±0.4)vs(1.8±0.4)mm,t=6.284 and 2.064,both P<0.05]as well as in one-time success group compared with the non-one-time success group[(147.5±6.2)°vs(135.2±4.7)°,(3.1±0.3)vs(2.8±0.6)mm,t=9.956 and 2.939,both P<0.05].Area under the curve of AsLPVDV and DDV in predicting one-time success of UVC were 0.944(95%CI:0.869-0.983)and 0.811(95%CI:0.708-0.890),respectively.The cut-off value was 140.4°for AsLPVDV and 2.9 mm for DDV,with the sensitivity of 93.0%and 90.7%,and specificity of 91.9%and 64.9%,respectively.Conclusions The success rate of UVC is related to AsLPVDV and DDV.AsLPVDV is of high value in predicting the one-time success of UVC.